Dens Evaginatus
Dens evaginatus is a relatively common developmental condition affecting predominantly premolar teeth (Leung’s premolars) (Figures 16-10 to 16-12). It has been reported almost exclusively in Asians, Inuits, and Native Americans. The defect, which is often bilateral, is an anomalous tubercle, or cusp, located at the center of the occlusal surface. Because of occlusal abrasion, the tubercle wears relatively quickly, causing early exposure of an accessory pulp horn that extends into the tubercle. This may result in periapical pathology in young, caries-free teeth, often before completion of root development and apical closure, making root canal fillings more difficult. Judicious grinding of the opposing tooth or the accessory tubercle to stimulate secondary dentin formation may prevent the periapical sequelae associated with this defect. Sealants, pulp capping, and partial pulpotomy have been suggested as measures to allow complete root development.